| Premier Psychology Consultants Pllc | |
|
1725 E Southlake Blvd Ste 102 Southlake TX 76092-6457 | |
| (682) 477-4400 | |
| Not Available |
| Full Name | Premier Psychology Consultants Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 1725 E Southlake Blvd Ste 102, Southlake, Texas |
| Authorized Official Name and Position | Marietta Richard (PH.D. / PSYCHOLOGIST) |
| Authorized Official Contact | 6824774400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Psychology Consultants Pllc 1725 E Southlake Blvd Suite 102 Southlake TX 76092 Ph: (682) 477-4400 | Premier Psychology Consultants Pllc 1725 E Southlake Blvd Ste 102 Southlake TX 76092-6457 Ph: (682) 477-4400 |
| NPI Number | 1942771787 |
|---|---|
| Provider Enumeration Date | 12/05/2018 |
| Last Update Date | 06/28/2019 |
| Medicare PECOS PAC ID | 1557602935 |
|---|---|
| Medicare Enrollment ID | O20190411002718 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942771787 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Marietta B Richard |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699950782 PECOS PAC ID: 3971680240 Enrollment ID: I20080410000573 |
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